1.Numrul solicitrii_____________________________________________________________ 2. Data solicitrii _______________________________________________________________ 3. Ora solicitrii________________________________________________________________ 4. Numele solicitantului__________________________________________________________ 5. Funcia solicitantului___________________________________________________________ 6. Date de contact ale solicitantului_________________________________________________ 7. Numele beneficiarului__________________________________________________________ 8. Data naterii a beneficiarului____________________________________________________ 9. Date de contact ale benificiarului_________________________________________________ 10. Numrul dosarului___________________________________________________________ 11.Fapta incriminat_____________________________________________________________ 12. Faza de desfurare a procesului________________________________________________ 13. Msura preventiv aplicat____________________________________________________ 14. Este/nu declarat persoan iresponsabil__________________________________________ 15. Dispune/nu dispune de defecte fizice sau mintale___________________________________ 16. Cunoate/nu cunoate suficient limba de stat_______________________________________ 17. Exist/nu exist coparticipani__________________________________________________ 18. Snt asistai coparticipanii de aprtor____________________________________________ 19. Este asistat partea vtmat/civil de aprtor_____________________________________ 20. A participat anterior un alt participant____________________________________________ 21.Temeiul nlocuirii aprtorului precedent___________________________________________ 22. Timpul, locul i aciunea procesual preconizat____________________________________